1396926440 NPI number — SUNRISE ENTERPRISE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396926440 NPI number — SUNRISE ENTERPRISE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNRISE ENTERPRISE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396926440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORNING SUN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52640-0244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-385-2910
Provider Business Mailing Address Fax Number:
319-385-2913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2925 CEDAR ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSCATINE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52761-2385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-263-7410
Provider Business Practice Location Address Fax Number:
563-263-7506
Provider Enumeration Date:
11/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAXON
Authorized Official First Name:
MONTA
Authorized Official Middle Name:
CITA
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
319-385-2910

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)